Hit Point Damage (3.5e Variant Rule)

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Strain damage is normally nonlethal damage, which goes away fairly quickly. Strain damage could also be done directly to the character’s hit points, making it more serious. Characters then have to balance their psychic skill use against damage they suffer in combat, and excessive psychic skill use can seriously injure or even kill a character. The damage dealt by strain is treated like any other damage and recovers at the same rate, meaning that psychic skills are more taxing and characters tend to use them sparingly.

The GM should decide whether hit point damage dealt by strain is subject to the Massive Damage rule (see the PHB), which requires a saving throw to avoid death if the character suffers massive damage.